AB1046 EFFICACY OF FEBUXOSTAT IN PATIENTS WITH GOUT STRATIFIED BY BASELINE RENAL FUNCTION
Authors: M. Eliseev, O. Sheliabina, M. Chikina
Journal: Annals of the Rheumatic Diseases (2022)

Background The opportunity of achievement of the target serum UA (sUA) level in pts with gout, stratified by renal function, is not studied. Objectives To compare the probability of the sUA level achievement during therapy with febuxostat in patients with gout, stratified according to renal function. Methods The prospective study included 136 pts aged ≥18 years with a crystal-verified diagnosis of gout and sUA level &gt;360 µmol/L who had never taken febuxostat or other urate-lowering drugs (at least 2 weeks before the start of the study). All pts were prescribed febuxostat 80 mg/day; if the target sUA level (&lt;360 µmol/l) was not achieved, the dose was increased to 120 mg/day. Prophylactic anti-inflammatory drugs (AIDs) were taken: colchicine in 59 (43.4%) pts, NSAIDs - 51 (37.58%) pts, GC - 12 (98.8%) pts. 14 (10.3%) pts did not take AIDs. Laboratory tests (serum levels of glucose, creatinine, UA) before and after 26 weeks of therapy were collected. GFR was calculated using CKD-EPI formula before and after therapy. The pts were initially divided into groups depending on the CKD stages according to the level of GFR (CKD-EPI): C1 – normal or high renal function (&gt;90 ml/min/1.73 m 2 ), C2 – mildly decreased (60-89 ml/min/1.73 m 2 ), C3 - moderately decreased (30-59 ml/min/1.73 m 2 ), C4 – severely decreased (15-29 ml/min/1.73 m 2 ). The observation period covered at least 26 weeks, the primary end point was the achievement of the target sUA level. The dynamics of GFR was also assessed. Statistica 12.0 package was used for statistical data processing. Results It was found that 30 (22.12%) pts had CKD stage 0-1, 28 (66-20.6%) pts - C2, 62 (45.6%) pts – C3, 16 (11.8%) – C4. 98 (72.1%) pts received febuxostat 80 mg/day, 38 (27.9%) pts - 120 mg/day. Pts with CKD C4 were older than ones with CKD C2 (p=0.00001) and CKD C0-1 (p=0.002); had a longer duration of gout (p=0.003); they were more likely to have subcutaneous tophi than pts with CKD C2 (p=0.007). The frequency of diagnosing DM, hypertension, as well as the sUA level in the groups did not differ. The levels of sUA, GFR in patients with gout, stratified by the level of GFR at baseline and after 26 weeks of febuxostat therapy, are given below (Table 1). Table 1. Levels of UA, eGFR in patients with gout, stratified by the level of eGFR at baseline and after 26 weeks of febuxostat therapy. Parameters All patients, n=136 CKD С0-1, n=30 CKD С2, n=28 CKD С3, n=62 CKD С4, n=16 UA baseline, µmol/l 472,4±99,3 451,9±102,8 486,9±103,8 476,9±86,7 468,3±109,8 UA after 26 weeks, µmol/l 306,27±104,4 298,6±104,8* 282,2±95,8* 318,9±97,6* 313,5±106,9* Δ UA, µmol/l 166±10,2 153,3±10,7 204,7±12,4 157,9±17,8 154,8±14,9 UA&lt;360 µmol/l, n (%) 117 (84) 25 (83) 25 (89) 51 (82) 13 (81) GFR baseline, ml/min/1.73 m 2 63,98±15,3 101,3±18,1 75,9±9,7 50,2±5,5 26,5±2,6 GFR after 26 weeks, ml/min/1.73 m 2 64,74±26,9 102,8±28,6* 76,7±9,3 50,9±6,9 27,3±4,9 * - p&lt;0.05 between baseline and 26 weeks The target sUA level was achieved in 33 (87%) patients with DM (the probability did not depend on the initial GFR value). Achievement of target sUA level was registered in 84% of general sample: in 83% of pts with CKD C0-1, 89% - CKD C2, 82% - CKD C3, 81% of pts with CKD C4. Mean GFR values increased in all groups, but significant differences registered in patients with CKD C0-1 (p=0.002) only. Conclusion The ability to achieve the target sUA level while taking febuxostat in patients with gout does not depend on renal function, exceeding 80% in patients with CKD C4. The drug is well tolerated regardless of renal function. Disclosure of Interests Maxim Eliseev Speakers bureau: Berlin Chemie Menarini Group, Sobi, EGIS, CSC, MosFarma, Alium Group, Olga Sheliabina Speakers bureau: Berlin Chemie Menarini Group, Maria Chikina: None declared